Chest Physiotherapy Procedure PDF

# Chest Physiotherapy ## Definitions * **Chest Physiotherapy:** Techniques intended to promote the drainage of secretions from the lungs. It includes postural drainage, percussion, and vibration. * **Postural drainage:** Uses position and gravity to drain secretions and mucus from the individual's...

# Chest Physiotherapy ## Definitions * **Chest Physiotherapy:** Techniques intended to promote the drainage of secretions from the lungs. It includes postural drainage, percussion, and vibration. * **Postural drainage:** Uses position and gravity to drain secretions and mucus from the individual's lungs. * **Percussion:** Using cupped hands to strike the chest repeatedly, producing sound waves that are transmitted through the chest, loosening secretions. ## Purposes 1. Facilitate airway clearance. 2. Effective in mobilizing pulmonary secretions in the postoperative patient, and those suffering pneumonitis, emphysema, asthma, chronic bronchitis, bronchiectasis, and cystic fibrosis. ## Assessment 1. Assess the patient's breath sounds via auscultation and the ability to clear secretions. 2. Determine the patient's rhythm, depth of breathing, and rate. 3. Observe the quality of the secretions. Humidification therapy may be necessary if secretions are thick and tenacious. 4. Take note of any complicating conditions: congestive heart failure, cerebral edema, head trauma, abdominal distention, arrhythmias, hypertension, or end stage chronic obstructive pulmonary disease (COPD). ## Preparation 1. Positions are determined by areas of involved lung, which are assessed by chest radiograph, percussion, palpation, and auscultation. 2. Chosen position is maintained for 5 to 15 minutes, although variations can be made if patient has trouble assuming various positions. 3. Usually done 2 to 4 times per day. 4. It is important to remember to perform this procedure 1 hour before meals or 1 to 3 hours after meals. 5. The patient with chest trauma, hemoptysis, heart disease, or head injury should not be placed into Trendelenburg's position. ## Equipment 1. Hospital bed or tilt board to place patient in Trendelenburg's position. 2. Pillows or blocks can be used to help position patients. 3. Tissues. 4. Container for sputum. 5. Mouthwash and emesis basin. # **Procedure:** 1. **Wash hands.** Rationale: *Reduces the transmission of microorganisms.* 2. **Close door and curtains.** Rationale: *Provides privacy.* 3. **Explain the procedure and Rationale for ECG.** Rationale: *Allays anxiety and promotes cooperation.* 4. **Bring ECG machine to the bedside and open electrode packages.** Rationale: *Assures smooth procedure* ## ECG machine 5. **Enter all demographic data into the machine.** Rationale: *Ensures accurate diagnosis for correct patient* 6. **Position the patient in a supine and relaxed position and drape with a sheet.** Rationale: *Provides comfort and privacy and ensures accurate ECG.* 7. **Remove moisture, oil, and excess hair from site at electrode sites.** Rationale: *Promotes adherence of leads to chest and extremities.* 8. **Apply the limb lead electrodes. The tip of each lead wire is lettered and color coded for easy identification. Position the electrodes with the lead connection pointing superiorly.** a. Green or "LL" lead to the left leg. b. Yellow or "LA" lead to the left arm. c. Red or "RA" lead goes to the right arm. d. Black or "RL" lead to the right leg. Rationale: *Having the lead connection pointing superiorly guarantees the best connection to the lead wire.* 9. **Apply electrode paste and attach electrodes to the chest** -V1-4th intercostal space (ICS) at right sternal border. -V2-4th ICS at left sternal border. -V3-Midway between V2 and V4. -V4-5th ICS at midclavicular line. -V5-Left anterior axillary line at level of V4 horizontally. -V6-Left midaxillary line at level of V4 horizontally. Rationale: *Promotes proper display of ECG on paper.* 10. **Attach lead wires to electrodes.** Rationale: *Ensures accurate tracing.* 11. **Obtain tracing by following the instructions from the physician. In general, a 2.5 second strip from each lead.** Rationale: *Data are gathered and transferred onto paper for analysis.* 12. **Inspect tracing for adequate quality.** Rationale: *Muscle movements may cause "fuzzy" waveforms. Normal cardiac waves are equal distances apart* 13. **Remove leads and electrodes. Wipe paste from skin.** Rationale: *Promotes comfort and hygiene, and minimizes skin irritation* 14. **Notify physician of abnormalities.** Rationale: *Certain changes may require prompt treatment.* 15. **Wash hands.** Rationale: *Reduces the transmission of microorganisms.* 16. **Return machine and replace supplies.** Rationale: *Assures equipment is ready for next use.* 17. **Documentation** -Date and time of the ECG -Reason for the ECG and any significant findings. -The time the tracing results were reported to physician Rationale: *This ensures continuity of care.* # **Positioning for Postural Drainage** 1. **Position patient to drain upper lung segments/lobes:** a. **Sitting upright in bed or chair-targets right and left chest.** Rationale: *Drains anterior right and left apical segments.* b. **Leaning forward in sitting position-targets back** Rationale: *Drains posterior right and left apical segments.* c. **Lying flat on back-targets right and left chest.** Rationale: *Drains anterior segments.* d. **Lying on abdomen, tilted to right or left side targets right or left back** Rationale: *Drains posterior segments.* 2. **Correct position to drain right posterior segment.** 3. **Position patient to drain middle lobe:** a. **Lying on back, tilted to left side in Trendelenburg's position - Targets right chest. ** Rationale: *Drains middle posterior lobe.* 4. **Correct position to drain right middle lobe.** 5. **Position patient to drain basal/lower lobes:** a. **Lying in Trendelenburg's position on back-targets right and left chest. Drains anterior basal lobes.** b. **Lying in Trendelenburg's position on abdomen targets right and left back. Drains posterior basal lobes.** 6. **Correct position to drain lower right and left lobes.** c. **Lying on abdomen targets right and left back. Drains superior basal lobes.** 7. **Correct position to drain right and left back** 8. **Maintain patient in position until chest percussion is completed (approximately 5 minutes).** Rationale: *Loosens secretions and facilitates removal.* # **Percussion and Vibration:** 1. **Instruct the patient to inhale slowly and deeply. Vibrate the chest wall as the patient exhales slowly through pursed lips:** a. Place one hand on top of the other over affected area or place one hand on each side of the rib cage. b. Tense the muscles of the hands and arms while applying moderate pressure downward and vibrate hands and arms. c. Relieve pressure on the thorax as the patient inhales. 2. **Assist patient into position for coughing or for suctioning of trachea** Rationale: *Removes secretions from lungs that accumulate in the trachea.* 3. **Auscultate chest areas for breath sounds.** Rationale: *If breath sounds are clear, secretions are cleared, if crackles are present, secretions may not be cleared, and nurse may repeat process.* 4. **Assist patient with mouth care.** Rationale: *Removes residual secretions from oral cavity, and freshens mouth.* 5. **Position patient in bed with head of bed elevated 45 degrees or more.** Rationale: *Facilitates lung expansion and deep breathing* 6. **Turn patient to side with pillow at back.** Rationale: *Facilitates movement of secretions.* 7. **Raise side rails, and place call light within reach.** Rationale: *Facilitates safety and communication with nurse.* 8. **Wash hands.** Rationale: *Reduces transmission of infection.* 9. **Documentation** -Patient's respiratory status, and compare to baseline. -Sputum characteristics and send to lab if ordered Rationale: *This ensures continuity of care.* <br>